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By Robert Hatcher, MD, MPH
Department of Gynecology and Obstetrics
Emory University School of Medicine
While a legislative bill introduced in Ohio in April 2019 would ban most private insurance coverage of abortion, it also may touch on contraception as well. Since the legislation bans coverage for “drugs or devices used to prevent the implantation of a fertilized ovum,” reproductive rights groups say it could eliminate coverage for some forms of contraception, such as birth control pills or intrauterine devices (IUDs).1
This is remarkable, since it is clearly these same contraceptives that most dependably prevent the NEED for an abortion.
American women, their physicians, and their nurse practitioners are aware that the contraceptives women use also are being used to treat or prevent several medical conditions. Following are just a few examples of how contraception is more than just birth control.
In a study of women with menorrhagia, findings suggest that the levonorgestrel (LNG) IUD is more effective than usual medical treatment in reducing the effect of heavy menstrual bleeding on quality of life.2 Hormonal agents, such as combined oral contraceptives, the contraceptive patch or vaginal ring, the single-rod contraceptive progestin implant, intramuscular and subcutaneous depot medroxyprogesterone acetate injectables, and the LNG IUD, are first-line agents for treating dysmenorrhea.3
In the 1950s, birth control pills were used to treat endometriosis before they were approved in 1960 as a method of birth control. In later years, findings of a 2003 study indicate that insertion of an LNG IUD after laparoscopic surgery for symptomatic endometriosis is effective in reducing the medium-term risk of recurrence of moderate or severe dysmenorrhea.4
Combined oral contraceptives have been shown to provide health benefits beyond birth control. These benefits include treatment of menstrual migraine and other cyclical headaches, as well as treatment for severe premenstrual symptoms.5 Pain and bleeding associated with uterine fibroids (the most common tumor in women, which usually are NOT cancerous), polycystic ovarian syndrome, acne, and painful sickle cell crises also are addressed by the use of hormonal contraceptives.
Ovarian cancer is decreased by the use of pills and other hormonal contraceptives. The longer a woman has used oral contraceptives, the greater the protective effect. And the protective effect lasts for years after the pills have been discontinued.6 Endometrial hyperplasia and endometrial cancer also are decreased by the use of pills and other hormonal contraceptives.7
Colon cancer is diminished by the use of pills and other hormonal contraceptives. The Nurses’ Health Study reported a 40% reduced risk of colorectal cancer with eight years of previous use of oral contraceptives. Fritz and Speroff conclude that “steroid contraception should be offered to women with a strong family history of colorectal cancer.”8
Perhaps Kate Miller, PhD, of the University of Pennsylvania may have put it best when she wrote in an introduction to the book Is Menstruation Obsolete? that “this monthly discomfort (cramps, pain, fatigue, irritability) is simply not obligatory.” Hormonal contraceptives are important now in the management of each of the above health problems affecting women during their reproductive years.
Contraceptives have contributed to a reduction in abortions, decreasing them to their lowest rate since shortly after the 1973 Roe v. Wade decision.9 Contraceptives also have been major contributors to a decrease in teen births. In 2018, the birth rate for teenagers ages 15-19 years fell 7% to 17.4 births per 1,000 women.10
It was old white men who gave us the Roe v. Wade decision in 1973; now it is predominantly old white men who would see Roe v. Wade overturned. Younger (on average) women of all races and social groups are leading the charge to maintain the right of women to use contraceptives to prevent the need for abortion and, when necessary, abortion to prevent unwanted births.
Financial Disclosure: Consulting Editor Robert A. Hatcher, MD, MPH, Nurse Planner Melanie Deal, MS, WHNP-BC, FNP-BC, Author Rebecca Bowers, Executive Editor Shelly Morrow Mark, Copy Editor Josh Scalzetti, and Editorial Group Manager Leslie Coplin report no consultant, stockholder, speaker’s bureau, research, or other financial relationships with companies having ties to this field of study.